Declines, and Pronounced Regional Disparities, in Meperidine Use in the United States

Abstract

AbstractPurposeThere have been increasing concerns about adverse effects and drug interactions with meperidine including removal from the World Health Organization’s list of essential medications. The goal of this study was to characterize pharmacoepidemiological patterns in meperidine use in the United States.MethodsMeperidine distribution data was obtained from the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS). Medicare Part D Prescriber Public Use Files (PUF) were utilized to capture overall trends in national meperidine prescriptions.ResultsNational meperidine distribution decreased from 2001 to 2019 by 94.6%. In 2019 Arkansas, Alabama, Oklahoma, and Mississippi saw significantly greater distribution per person when compared to the average state (9.27, SD = 6.82). Meperidine per ten persons showed an eighteen-fold difference between the highest (Arkansas = 36.8 mg) and lowest (Minnesota = 2.1 mg) states. Five of the six lowest states were in the northeast. Meperidine distribution per state was significantly correlated with the prevalence of adult obesity (r(47) = +0.47, p < 0.001).Family medicine and internal medicine physicians accounted for 28.9% and 20.5% of Medicare Part D total daily supply (TDS) of meperidine in 2017. However, interventional pain management (5.66) and pain management (3.48) physicians accounted for the longest while family medicine (0.69) and internal medicine (0.40) accounted for the shortest TDS per provider.ConclusionUse of meperidine has been declining over the last two-decades. Meperidine distribution varied on a geographical level with south/south-central, and more obese, states showing appreciably greater distribution per person. Primary care doctors continue to account for the majority of meperidine daily supply, but specialists like interventional pain management were the most likely to prescribe meperidine to Medicare patients. Increasing knowledge of meperidine’s undesirable adverse effects (e.g. seizures) and serious drug-drug interactions likely are responsible for these pronounced reductions.